孤立性蝶窦病变的诊治

目的总结孤立性蝶窦病变的临床表现及诊断治疗的方法。方法回顾分析2006年12月—2011年9月在我科诊治的12例孤立性蝶窦病变的临床资料。结果 12例病人术前均经CT或MRI检查后诊断,术后病理证实。其中良性病变11例:孤立性蝶窦炎4例,霉菌性蝶窦炎5例,囊肿2例;蝶窦腺癌1例。临床表现为头痛9例,眼球胀痛1例,涕血1例,头晕1例。所有病例均采用鼻内镜手术,术后随访3个月～3年。良性病变术后症状显著缓解或消失,无复发。蝶窦腺癌者术后头痛无改善,术后放化疗,9个月后肺部、肝脏等多处转移,3年后死于多脏器衰竭。结论对于不明原因的头痛、进行性视力下降的患者,应行CT或MRI并可结合鼻内镜检查,以便早期诊断,病理能够确诊。鼻内镜手术是治疗良性孤立性蝶窦疾病的首选。

Experience of diagnosis and treatment of isolated sphenoid sinus diseases

Objective To summarize the clinical manifestations and diagnosis and treatment of isolated sphenoid sinus diseases.Methods The clinical data of 12 patients with isolated sphenoid sinus disease from December 2006 to September 2011 were retrospectively reviewed.Results Twelve cases with isolated sphenoid sinus diseases were diagnosed by CT/MRI scan,and verified by pathology.Eleven cases were benign,including 4 sinusitis,5 rhinomycosis,2 cyst.One case was adenocarcinoma.Headache was the most common symptom(9 patients) among all patients.Other symptoms included eye pain(1),epistaxis(1) and dizziness(1).All the cases were treated with endoscopic sinus surgery.Clinical follow-up ranged from 3 months to 3 years.The symptoms of the benign cases were improved or eliminated after surgery.However the headache of the adenocarcinoma was not relieved after surgery.Although treated with radiation and chemotherapy,the patient had metastases in lung and liver after 9 months,and 3 years later died of multiple organ failure.Conclusion Diagnostic nasal endoscopic procedures and imaging techniques are of great value for an early and precise diagnosis to clinical unknown reason of headache,and eye symptoms.Endoscopic sinus surgery is the primary therapy for isolated sphenoid sinus disease.